First-line endoscopic treatment with over-the-scope clips in patients with either upper or lower gastrointestinal bleeding: a multicenter study

Abstract

Background and study aims Endoscopic treatment is the mainstay approach for gastrointestinal bleeding, in either upper (UGIB) or lower (LGIB) tract. The over-the-scope clip (OTSC) may overcome limitations of standard clips or thermocoagulation in high-risk bleeding lesions. We evaluate the main clinically relevant outcomes following endoscopic hemostasis with OTSC in high-risk lesions and/or patients.

Patients and methods This was a retrospective analysis of prospectively collected databases including all patients with UGIB and LGIB who underwent OTCS placement as first-line treatment in eleven tertiary endoscopic referral centers. Technical success, primary hemostasis, rebleeding, blood transfusion, hospital stay, and hemorrhage-related mortality rates were evaluated.

Results Data from 286 patients, with either UGIB (N = 214) or LGIB (N = 72) were available. Overall, 112 patients (39.2 %) were receiving antithrombotic therapy. Technical success and primary hemostasis rates were 97.9 % and 96.4 %, respectively. Early rebleeding occurred in 4.4 %, more frequently in those on antithrombotic therapy, and no late rebleeding was observed. Following a successful primary haemostasis, only 5.2 % patients needed blood transfusions, and the median hospital stay was 4 days (range: 3 – 11). Eighteen patients with either technical failure (N = 6) or rebleeding (N = 12) underwent radiological or surgical approaches. Overall, bleeding-related deaths occurred in 5 (1.7 %) patients, including 3 patients with technical procedural failure, and 2 in the rebleeding group. 

Conclusions Data from our large, multicenter study show that OTSC placement is an effective first-line treatment for hemostasis in high-risk patients and/or lesions both in upper and lower gastrointestinal tract.

• References

• 1 van Leerdam ME. Epidemiology of acute upper gastrointestinal bleeding. Best Pract Res Clin Gastroenterol 2008; 22: 209-224
• 2 Hearnshaw SA, Logan RF, Lowe D. et al. Acute upper gastrointestinal bleeding in the UK: patient characteristics, diagnoses and outcomes in the 2007 UK audit. Gut 2011; 60: 1327-1335
• 3 Laine L, Yang H, Chang SC. et al. Trends for incidence of hospitalization and death due to GI complications in the United States from 2001 to 2009. Am J Gastroenterol 2012; 107: 1190-1195
• 4 Strate LL, Ayanian JZ, Kotler G. et al. Risk factors for mortality in lower intestinal bleeding. Clin. Gastroenterol Hepatol 2008; 6: 1004-1010
• 5 Gralnek IM, Dumonceau JM, Kuipers EJ. et al. Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy 2015; 47: 1-46
• 6 Garber A, Jang S. Novel therapeutic strategies in the management of non-variceal upper gastrointestinal bleeding. Clin Endosc 2016; 49: 421-424
• 7 Chan SM, Lau JYW. Can we now recommend OTSC as first-line therapy in case of non-variceal upper gastrointestinal bleeding?. Endosc Int Open 2017; 05: E883-E885
• 8 Beales I. Recent advances in the management of peptic ulcer bleeding. F1000Research 2017; 6: 1763 , (F1000 Faculty Rev)
• 9 Goelder SK, Brueckner J, Messmann H. Endoscopic hemostasis state of the art - nonvariceal bleeding. World J Gastrointest Endosc 2016; 8: 205-211
• 10 Kirschniak A, Kratt T, Stüker D. et al. A new endoscopic over-the-scope clip system for treatment of lesions and bleeding in the GI tract: first clinical experiences. Gastrointest Endosc 2007; 66: 162-167
• 11 Manta R, Caruso A, Cellini C. et al. Endoscopic management of patients with post-surgical leaks involving the gastrointestinal tract: a large case series. United European Gastroenterol J 2016; 4: 770-777
• 12 Tashima T, Ohata 1 K, Sakai E. et al. Efficacy of an over-the-scope clip for preventing adverse events after duodenal endoscopic submucosal dissection: a prospective interventional study. Endoscopy 2018; 50: 487-496
• 13 Manta R, Galloro G, Mangiavillano B. et al. Over-the-scope clip (OTSC) represents an effective endoscopic treatment for acute GI bleeding after failure of conventional techniques. Surg Endosc 2013; 27: 3162-3164
• 14 Richter-Schrag HJ, Glatz T, Walker C. et al. First-line endoscopic treatment with over-the-scope clips significantly improves the primary failure and rebleeding rates in high-risk gastrointestinal bleeding: a single-center experience with 100 cases. World J Gastroenterol 2016; 22: 9162-171
• 15 Wedi E, Fischer A, Hochberger J. et al. Multicenter evaluation of first-line endoscopic treatment with the OTSC in acute non-variceal upper gastrointestinal bleeding and comparison with the Rockall cohort: the FLETRock study. Surg Endosc 2018; 32: 307-314
• 16 Lamberts R, Koch A, Binner C. et al. Use of over-the-scope clips (OTSC) for hemostasis in gastrointestinal bleeding in patients under antithrombotic therapy. Endoscopy International Open 2017; 05: E324-E330
• 17 Brandler J, Buttar N, Baruah A. et al. Efficacy of Over the Scope Clips in management of high-risk gastrointestinal bleeding. Clin Gastroenterol Hepatol 2018; 16: 690-696.e1
• 18 Schmidt A, Goelder S, Messmann H. et al. Over-the-scope-clips versus standard endoscopic therapy in patients with recurrent peptic ulcer bleeding. A prospective, randomized, multicenter trial (Sting). Gastroenterology 2018; 155: 674-686